Interesting update on HealthyGamerGG (Dr. K)

[StilgarMD]

Recall hearing folks discussing this case on this forum a while back, though some folks would want to know he has in fact been reprimanded by the Mass Board. I'm not sure what the overall consequences of such actions are, but it is good that something is being done to address the seemingly obvious practice of therapy by someone live streamed for entertainment purposes.

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[Merovinge]

Wild, did HealthygamerGG get the post taken down?

 

[calvnandhobbs68]

Wild, did HealthygamerGG get the post taken down?

Yeah just taken off with no explanation...pretty suspicious.

For everyone else, here's the actual link the to consent order since it's no longer linked through the reddit post, which we should have no basis to remove because this is a publicly available document released by the medical board of Massachusetts:

https://www.mass.gov/doc/consent-order-for-dr-kanojia-6-10-24-pdf/download

Unfortunately OP there is likely to be very little repercussion from this besides the reprimand itself having to be reported to other medical boards. He has to report this to any agency he works with but since he basically just runs a private practice and his online stuff which is a bunch of "coaching" programs, it's not gonna impact day to day operations. I assume he may just take less direct involvement with the "coaching" aspect of things.

In my opinion the whole "coaching" industry is ridiculous and is basically either actual licensed professionals trying to avoid the liability with saying they're entering into a clinician/patient relationship or unlicensed individuals trying to pretend they're doing "psychotherapy" under a different name. If you watch this guy's videos he's clearly crossing this line over and over again...there's one video where a girl is basically telling him she has active SI, has a plan and her friends keep an eye on her all the time to keep her from actually harming herself and his response is along the lines of "you should really tell your psychiatrist about that".

The APA is unfortunately very wishy washy about this despite the obvious ethical pitfalls. The APA ethics committee has very...interesting opinions at times however.
In the same opinion release they say that it's unethical to do an internet search about a prospective patient to decide whether to take them on as a patient and that you can't have any friendly social interactions with any of your former patients in your small town after you close your practice.
They then go on to say it's totally fine to run a "coaching" business using their medical credentials and advertising themselves as a psychiatrist but just telling people that "if a coaching client seems to exhibit psychiatric symptoms, the Committee recommends referring to a different doctor, to keep lines clear"....

https://www.psychiatry.org/getmedia/057ca081-efd7-4017-8b03-a4206a58f36f/APA-Recent-Ethics-Opinions.pdf

 

[Merovinge]

Yeah just taken off with no explanation...pretty suspicious.

For everyone else, here's the actual link the to consent order since it's no longer linked through the reddit post, which we should have no basis to remove because this is a publicly available document released by the medical board of Massachusetts:

https://www.mass.gov/doc/consent-order-for-dr-kanojia-6-10-24-pdf/download

Unfortunately OP there is likely to be very little repercussion from this besides the reprimand itself having to be reported to other medical boards. He has to report this to any agency he works with but since he basically just runs a private practice and his online stuff which is a bunch of "coaching" programs, it's not gonna impact day to day operations. I assume he may just take less direct involvement with the "coaching" aspect of things.

In my opinion the whole "coaching" industry is ridiculous and is basically either actual licensed professionals trying to avoid the liability with saying they're entering into a clinician/patient relationship or unlicensed individuals trying to pretend they're doing "psychotherapy" under a different name. If you watch this guy's videos he's clearly crossing this line over and over again...there's one video where a girl is basically telling him she has active SI, has a plan and her friends keep an eye on her all the time to keep her from actually harming herself and his response is along the lines of "you should really tell your psychiatrist about that".

The APA is unfortunately very wishy washy about this despite the obvious ethical pitfalls. The APA ethics committee has very...interesting opinions at times however.
In the same opinion release they say that it's unethical to do an internet search about a prospective patient to decide whether to take them on as a patient and that you can't have any friendly social interactions with any of your former patients in your small town after you close your practice.
They then go on to say it's totally fine to run a "coaching" business using their medical credentials and advertising themselves as a psychiatrist but just telling people that "if a coaching client seems to exhibit psychiatric symptoms, the Committee recommends referring to a different doctor, to keep lines clear"....

https://www.psychiatry.org/getmedia/057ca081-efd7-4017-8b03-a4206a58f36f/APA-Recent-Ethics-Opinions.pdf

Thank you for that, I had no idea the APA was as pitiful about the "coaching" industry.

Separately, what an incredible friend to reach out to an actively licensed/actively practicing psychiatrist who completed training at Harvard 2 days before his friend completed suicide.

IMO if you want to get into mental health coaching as a psychiatrist, I wouldn't hold your past training against you. You can surrender your license to practice medicine and get on with your pseudoscience self. I am not sure if I am more frustrated by this psychiatrist or the APA now that I read all about this...

 

[comp1]

So yeah, lines were crossed. The reprimand is appropriate. That said...I'm guessing in 10 years this sort of thing will look quaint and probably be very confusing for newly minted psychiatrists about what exactly was wrong. The times, they are a-changing.

 

[calvnandhobbs68]

So yeah, lines were crossed. The reprimand is appropriate. That said...I'm guessing in 10 years this sort of thing will look quaint and probably be very confusing for newly minted psychiatrists about what exactly was wrong. The times, they are a-changing.

I mean if you know much history of psychotherapy not really....people have been trying to do this "make money from therapy without getting into that sticky doctor-patient relationship" stuff for a long time. "Encounter groups" from the 1960-70s anyone?

https://www.psychiatry.org/File%20Library/Psychiatrists/Directories/Library-and-Archive/task-force-reports/tfr1970_EncounterGroups.pdf

"the participants are not labeled patients; the experience is not labeled “therapy,” but nonetheless the groups strive to increase inner awareness and to change behavior"...."Many of the encounter groups have no institutional backing and recruit participants by word of mouth or written advertisement. Some teachers lead encounter groups in the classroom, housewives lead groups at their homes for their friends or the friends of their adolescent offspring"

Sound familiar?

 

[R. Matey]

Unfortunately OP there is likely to be very little repercussion from this besides the reprimand itself having to be reported to other medical boards. He has to report this to any agency he works with but since he basically just runs a private practice and his online stuff which is a bunch of "coaching" programs, it's not gonna impact day to day operations. I assume he may just take less direct involvement with the "coaching" aspect of things.

Am I correct in understanding that a reprimand is essentially a 'cease-and-desist' for the unethical behavior in question?

 

[romanticscience]

I mean if you know much history of psychotherapy not really....people have been trying to do this "make money from therapy without getting into that sticky doctor-patient relationship" stuff for a long time. "Encounter groups" from the 1960-70s anyone?

https://www.psychiatry.org/File%20Library/Psychiatrists/Directories/Library-and-Archive/task-force-reports/tfr1970_EncounterGroups.pdf

"the participants are not labeled patients; the experience is not labeled “therapy,” but nonetheless the groups strive to increase inner awareness and to change behavior"...."Many of the encounter groups have no institutional backing and recruit participants by word of mouth or written advertisement. Some teachers lead encounter groups in the classroom, housewives lead groups at their homes for their friends or the friends of their adolescent offspring"

Sound familiar?

Also, in reference to the question about coaching:

The psychiatrist must be quite careful to stay on the correct side of that line— if a coaching client seems to exhibit psychiatric symptoms, the Committee recommends referring to a different doctor to keep lines clear.

What isn't a psychiatric symptom nowadays? Anxiety? Inattention? Distracted? Stressed? MDD, GAD, and ADHD have everything covered

 

[Proudfather94]

From what I read of that article he def did go a little too close to the sun with Reckful. If one just posted that convo you would def think he was being a therapist

 

[Merovinge]

From what I read of that article he def did go a little too close to the sun with Reckful. If one just posted that convo you would def think he was being a therapist

Yes if "a little to close too the sun" includes several hours of streamed "coaching" touching on suicide, abandonment issues, family of origin concerns, than sure, I guess. If you also mean that people reaching out to you about this person who you coached for several hours on livestream to mention they thought he was going to end his life and then he did 2 days later, it might have made some sense to ensure there was ongoing actual psychiatric care, given that you know, you are a licensed psychiatrist.

I will add, that I have watched a fair amount of Dr. K's stuff and I actually think he generally does a solid job connecting with his userbase in a mostly evidenced base way. If he stopped clinical practice and did that, I wouldn't have a concern. But being a practicing psychiatrist and then doing something that is almost exactly the same but pretending it is not a doctor/patient relationship seems... problematic, to say the least.

 

[futureapppsy2]

Yes if "a little to close too the sun" includes several hours of streamed "coaching" touching on suicide, abandonment issues, family of origin concerns, than sure, I guess. If you also mean that people reaching out to you about this person who you coached for several hours on livestream to mention they thought he was going to end his life and then he did 2 days later, it might have made some sense to ensure there was ongoing actual psychiatric care, given that you know, you are a licensed psychiatrist.

I will add, that I have watched a fair amount of Dr. K's stuff and I actually think he generally does a solid job connecting with his userbase in a mostly evidenced base way. If he stopped clinical practice and did that, I wouldn't have a concern. But being a practicing psychiatrist and then doing something that is almost exactly the same but pretending it is not a doctor/patient relationship seems... problematic, to say the least.

He also gave at least one diagnosis to Reckful, scheduled follow-up appointments, etc--it was definitely therapy. (Also, telling someone who you think has BPD that you are going to "love them for two years" so that their BPD will go away while simultaneously streaming their treatment as long as it brings you enough views and subs is such a nightmare idea that I don't even know where to start).

 

[aim-agm]

Yes if "a little to close too the sun" includes several hours of streamed "coaching" touching on suicide, abandonment issues, family of origin concerns, than sure, I guess. If you also mean that people reaching out to you about this person who you coached for several hours on livestream to mention they thought he was going to end his life and then he did 2 days later, it might have made some sense to ensure there was ongoing actual psychiatric care, given that you know, you are a licensed psychiatrist.

I will add, that I have watched a fair amount of Dr. K's stuff and I actually think he generally does a solid job connecting with his userbase in a mostly evidenced base way. If he stopped clinical practice and did that, I wouldn't have a concern. But being a practicing psychiatrist and then doing something that is almost exactly the same but pretending it is not a doctor/patient relationship seems... problematic, to say the least.

He flew a little too close to the sun...and then kept flying until he collided with it.

 

[Liquid8]

Watched the first of his Reckful interviews – for me there are a few issues.

Initial impression is that he doesn’t strike me as a great interviewer in a general sense. When I think about great talk show hosts or journalists, they are usually prepared for their special guests. It didn’t seem like he was, which I suppose can be forgiven due to the nature of streaming. But I also felt that he also interrupted and talked far too much, and shoehorned piecemeal bits of information – as if trying to educate like in a lecture. It just felt quite disjointed.

Now I’m not in a position to say if he’s a good psychiatric interviewer or not, as I'll give him the benefit of the doubt in that I don’t think that was what he set out to do, but I think he wasn’t clear in what he was trying to achieve either. Part of that also relates to him throwing out various questions that wouldn’t be out of place in a psychiatric interview. For example, he talked about tending to ask a lot of questions and for Reckful not to answer anything that made him uncomfortable. Have used statements of this nature in cases where a patient has been seen by a few different clinicians in a busy emergency department, and could be agitated from being asked the same questions multiple times. But if I was having an interview with say, a local politician it’s not an option I’d give them as it would give them too many easy outs. Dr K alludes to being friends with lots of these streamers, but if you are having a conversation amongst friends, then you don’t have to give a disclaimer like this as you would already have some self-awareness about what topics not to touch on.

I also thought it was interesting that early on Reckful mentions his brother’s suicide at a young age; and Dr K seemed to skirt around that issue – probably appropriately, but later on they’re talking about Reckful being depressed in his younger years and Dr K states there doesn’t seem to be any reason for it and starts questioning the validity of his past diagnoses. To me this is overstepping the mark, but I’m also sitting here thinking that he’s missed a really obvious link. This made me recall my final psychiatry exam, where we would see a patient observed by two psychiatrists. After a 50 minute interview we’d present the case and if a patient had told me what Reckful told Dr K and I didn’t explore the issue or make that connection when presenting my findings – the observers likely would have identified the gap, which would be a likely fail. But with Dr K if it’s not a clinical interview, does it actually matter? I’d say it doesn’t, but if I put on my psychiatrist hat – it just doesn’t feel quite right.

 

[calvnandhobbs68]

The Gamer and the Psychiatrist

Did Dr. Alok Kanojia's livestreamed conversations with a troubled video game champion cross an ethical line?

www.nytimes.com

I have to admit I didn't watch the full episodes of all these, just parts but seriously this guy....

“Hopefully I don’t get sued because I’m not really delivering medical care,” he said about an hour into their first conversation. “You know, what happens if someone comes on stream and then kills themselves or something like that?”
“I’ll try not to kill myself anytime soon for you,” Mr. Bernstein replied with an easy smile.
“Yeah, thank you,” Dr. Kanojia said, his expression serious. “I appreciate that. I’m serious.”
“Yeah, no problem,” Mr. Bernstein said.

Yes, this is often how I approach suicide with my patients. "Please don't kill yourself because I might get sued".

Then he starts going on a livestream and crying about how his "HP bar is down" after Reckful's death? I mean I suppose this makes sense if you truly thought you were 100% divested from your role as a professional and were just making some stream about your friend dying but he's doing this in the context of a business where he is providing professional advice and treatment.

He just seems extremely immature and with very poor insight into his own behavior.

 

[comp1]

I'd kind of like to hear from someone his age or younger. I'm just wondering about the culture shift we're seeing.

 

[calvnandhobbs68]

I'd kind of like to hear from someone his age or younger. I'm just wondering about the culture shift we're seeing.

Where are you getting the idea he's a young guy? Because he plays video games? Dude's 41 years old. He's not some Gen Zer

I'll let you know I'm >5 years younger than him.

 

[neglect]

Am I correct in understanding that a reprimand is essentially a 'cease-and-desist' for the unethical behavior in question?

In this case the "patient" committed suicide, so the behavior ceased.

The NYTimes did a piece on this today. I came here to see what you guys thought. I thank the above posters @calvnandhobbs68 and @Liquid8 who so clearly see the problems with this approach, but perhaps balanced with decreasing stigma and platforming real help. But the first rule is do no harm. He endangered this person by failing to establish boundaries.

Boy oh boy, I hope some lessons were learned. But based on the article that's not the case, and he sees this as a vindication. The fact that Vivek Murthy is involved with this guy does not reflect well.